Type 2 Diabetes

Need to Know

Also known as adult-onset diabetes , type 2 diabetes can often be managed by carefully monitoring your diet. According to research or other evidence, the following self-care steps may be helpful.

Keep an eye on the GI
Follow a low-glycemic-index diet by avoiding sweet snacks and processed foods, and emphasizing healthy carbohydrates from whole grains, beans, vegetables, and whole fruit, to help keep blood sugar levels stable.
Fight back with fiber
In addition to eating plenty of high-fiber fruits and vegetables, consider using a fiber supplement such as glucomannan or psyllium with meals.
Energize insulin function with weight loss and exercise
Lower your blood sugar and improve insulin function with weight loss and regular exercise.
Check out chromium
Improve glucose tolerance by taking 200 to 1,000 mcg of this essential trace mineral every day.
Improve and protect with ALA
Take 600 to 1,200 mg a day of an alpha lipoic acid supplement to improve insulin sensitivity and help protect against diabetic complications such as nerve damage.
Try a topical ointment
An ointment containing 0.025 to 0.075% capsaicin four times a day might help control nerve pain.

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading for more in-depth, fully referenced information.

Aim for a healthy weight
Lose excess weight with a program of healthy eating, regular exercise, and group support to maintain healthy insulin sensitivity and prevent type 2 diabetes.
Get moving
Use regular aerobic and/or strength exercise to maintain healthy insulin sensitivity and prevent type 2 diabetes.
Keep an eye on the GI
Choose carbohydrate foods with a low glycemic index, such as whole grains, beans (legumes), and other high-fiber, unprocessed foods, to stabilize blood sugar and reduce diabetes risk.
Go vegetarian or vegan
Vegetarians have been shown to have a low risk of type 2 diabetes.
Add some olive oil
Extra virgin olive oil is a good source of monounsaturated fat. Increasing monounsaturated fats relative to other dietary fats has been shown to improve glucose tolerance.

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading for more in-depth, fully referenced information.

About

About This Condition

Diabetes mellitus is an inability to metabolize carbohydrates resulting from inadequate insulin production or utilization. Other forms of diabetes (such as diabetes insipidus) are not included in this discussion.

There are two types of diabetes mellitus, type 1 and type 2. This article concerns type 2 diabetes, which has also been called adult-onset diabetes or non-insulin-dependent diabetes. However, type 2 diabetes may also affect children and may also require treatment with insulin. With type 2 diabetes, the pancreas often makes enough insulin, but the body has trouble using it. Type 2 diabetes frequently responds well to natural therapies.

People with diabetes cannot properly process glucose, a sugar the body uses for energy. As a result, glucose stays in the blood, causing blood glucose to rise. At the same time, however, the cells of the body can be starved for glucose. People with diabetes are at high risk for heart disease, atherosclerosis, cataracts, retinopathy, stroke, poor wound healing, infections, and damage to the kidneys and nerves. In addition, those with diabetes have a higher mortality rate if they also have high homocysteine levels.¹

Holistic Options

Acupuncture may be helpful in the treatment of diabetes, or complications associated with diabetes. Preliminary trials have suggested that acupuncture can lower blood sugar and improve insulin production in people with type 2 diabetes,² ^{, 3} ^{, 4} ^{, 5} but trials on long-term effects have not been concluded. In a preliminary trial, 77% of people suffering from diabetic neuropathy experienced significant reduction in pain following up to six acupuncture treatments over a ten-week period. Many were also able to reduce pain medications, but no long-term change in blood-sugar control was observed.⁶ Bladder control problems, a complication of long-term diabetes, responded to acupuncture treatment with a significant reduction in symptoms in both controlled and uncontrolled trials.⁷ ^{, 8}

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation	Why	Get started
Add some olive oil	Extra virgin olive oil is a good source of monounsaturated fat. Increasing monounsaturated fats relative to other dietary fats has been shown to improve glucose tolerance.
Add some olive oil Diets high in fat, especially saturated fat, worsen glucose tolerance and increase the risk of type 2 diabetes,⁹ ^{, 10} ^{, 11} ^{, 12} an effect that is not simply the result of weight gain caused by eating high-fat foods. Saturated fat is found primarily in meat, dairy fat, and the dark meat and skins of poultry. In contrast, glucose intolerance has been improved by diets high in monounsaturated oils,¹³ ^{, 14} which may be good for people with diabetes.¹⁵ The best way to incorporate monounsaturates into the diet is to use olive oil, especially extra virgin olive oil, which has high antioxidant values.
Feast on fish	In one study, incorporating a fish meal into a weight-loss regimen was more effective than either measure alone at improving glucose and insulin metabolism and high cholesterol.
Feast on fish Eating fish also may afford some protection from diabetes.¹⁶ Incorporating a fish meal into a weight-loss regimen was more effective than either measure alone at improving glucose and insulin metabolism and high cholesterol.¹⁷
Fight back with fiber	Research has shown a high-fiber diet may work better in controlling diabetes than the diet recommended by the American Diabetic Association, and may control blood sugar levels as well as oral diabetes drugs.
Fight back with fiber A high-fiber diet has been shown to work better in controlling diabetes than the diet recommended by the ADA, and may control blood sugar levels as well as oral diabetes drugs.¹⁸ In this study, the increase in dietary fiber was accomplished exclusively by eating foods naturally high in fiber—such as leafy green vegetables, granola, and fruit—to a level beyond that recommended by the ADA. No fiber supplements were given. All participants received both the ADA diet (providing 24 grams of fiber per day) and the high-fiber diet (providing 50 grams of fiber per day) for a period of six weeks. After six weeks of following each diet, tests were performed to determine blood glucose, insulin, cholesterol, triglyceride, and other values. When glucose levels were monitored over a 24-hour period, participants eating the high-fiber diet had an average glucose level that was 10% lower than participants eating the ADA diet. Insulin levels were 12% lower in the group eating the high-fiber diet compared to the group eating the ADA diet, indicating a beneficial increase in the body’s sensitivity to insulin. Moreover, people eating the high-fiber diet experienced significant reductions in total cholesterol, triglycerides, and LDL (“bad”) cholesterol compared with those eating the ADA diet. They also had slight decreases (improvements) in glycosylated hemoglobin levels, a measure of long-term blood glucose regulation. High-fiber supplements, such as psyllium,¹⁹ guar gum (found in cluster beans),²⁰ pectin (from fruit),²¹ oat bran,²² and glucomannan,²³ ^{, 24} have improved glucose tolerance in some studies. Positive results have also been reported with the consumption of 1 to 3 ounces of powdered fenugreek seeds per day.²⁵ ^{, 26} A review of the research revealed that the extent to which moderate amounts of fiber help people with diabetes in the long term is still unknown, and the lack of many long-term studies has led some researchers to question the importance of fiber in improving diabetes.²⁷ Nonetheless, most doctors advise people with diabetes to eat a diet high in fiber. Focus should be placed on fruits, vegetables, seeds, oats, and whole-grain products.
Go vegetarian or vegan	Vegetarians have been shown to have a low risk of type 2 diabetes, and when people with diabetic nerve damage switch to a vegan diet, improvements have been reported after several days.
Go vegetarian or vegan Vegetarians also eat less protein than do meat eaters. Reducing protein in the diet has lowered kidney damage caused by diabetes and may also improve glucose tolerance.²⁸ ^{, 29} and may also improve glucose tolerance.³⁰ However, in a group of 13 obese males with high blood-insulin levels (as is often seen in diabetes), a high-protein, low-carbohydrate diet resulted in greater weight loss and control of insulin levels, compared with a high-carbohydrate diet.³¹ Switching to either a high- or low-protein diet should be discussed with a doctor.
Keep an eye on the GI	Whole grains, beans, vegetables, and fruit help keep blood sugar levels stable because their low glycemic index does not cause blood sugar to spike.
Keep an eye on the GI The relationship between eating carbohydrates and type 2 diabetes is complex. While eating carbohydrates increases the need for insulin to keep blood sugar normal, diets high in total carbohydrates do not necessarily increase the risk of type 2 diabetes.³² ^{, 33} Researchers have found that diets very high in sugar may worsen glucose tolerance in nondiabetic animals and humans.³⁴ ^{, 35} However, the amount of sugar used in these studies in proportion to other foods was much larger than is typically found in human diets. Eating carbohydrate-containing foods, whether high in sugar or high in starch (such as bread, potatoes, processed breakfast cereals, and rice), temporarily raises blood sugar and insulin levels.³⁶ The blood sugar–raising effect of a food, called its “glycemic index,” depends on how rapidly its carbohydrate is absorbed. Many starchy foods have a glycemic index similar to table sugar (sucrose).³⁷ People eating large amounts of foods with high glycemic indexes have been reported to be at increased risk of type 2 diabetes. ³⁸ ^{, 39} On the other hand, eating a diet high in carbohydrate-rich foods with low glycemic indexes is associated with a low risk of type 2 diabetes. ⁴⁰ ^{, 41} ^{, 42}Beans, peas, fruit, and oats have low glycemic indexes, despite their high carbohydrate content, due mostly to the health-promoting effects of soluble fiber. Diabetes disrupts the mechanisms by which the body controls blood sugar. Until recently, health professionals have recommended sugar restriction to people with diabetes, even though short-term high-sugar diets have been shown, in some studies, not to cause blood sugar problems in people with diabetes.⁴³ ^{, 44} ^{, 45} Currently, the American Diabetic Association (ADA) guidelines do not prohibit the use of moderate amounts of sugar,⁴⁶ as long as blood levels of glucose, triglycerides, and cholesterol are maintained within normal levels. Most doctors recommend that people with diabetes to reduce the amount of sugar eaten in snacks and processed foods, and replace these foods with high-fiber, whole foods. This tends to lower the glycemic index of the overall diet and has the additional benefit of increasing vitamin, mineral, and fiber intake. Other authorities also recommend lowering the glycemic index of the diet to improve the control of diabetes.⁴⁷
Limit sugar	Most doctors recommend that people with diabetes eat less sugary foods like snacks and processed foods and replace these foods with high-fiber, whole foods.
Limit sugar Diabetes disrupts the mechanisms by which the body controls blood sugar. Until recently, health professionals have recommended sugar restriction to people with diabetes, even though short-term high-sugar diets have been shown, in some studies, not to cause blood sugar problems in people with diabetes.⁴⁸ ^{, 49} ^{, 50} Currently, the American Diabetic Association (ADA) guidelines do not prohibit the use of moderate amounts of sugar,⁵¹ as long as blood levels of glucose, triglycerides, and cholesterol are maintained within normal levels. Most doctors recommend that people with diabetes to reduce the amount of sugar eaten in snacks and processed foods, and replace these foods with high-fiber, whole foods. This tends to lower the glycemic index of the overall diet and has the additional benefit of increasing vitamin, mineral, and fiber intake. Other authorities also recommend lowering the glycemic index of the diet to improve the control of diabetes.⁵²

Supplements

What Are "Star" Ratings?

a7_3star Reliable and relatively consistent scientific data showing a substantial health benefit.

a7_2star Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

a7_1star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

Supplement	Amount	Why
Alpha Lipoic Acid	600 to 1,200 mg a day	Taking alpha lipoic acid may improve insulin sensitivity and help protect against diabetic complications such as nerve damage.
Alpha Lipoic Acid 600 to 1,200 mg a day Alpha lipoic acid is a powerful natural antioxidant. Preliminary and double-blind trials have found that supplementing 600 to 1,200 mg of lipoic acid per day improves insulin sensitivity and the symptoms of diabetic neuropathy.⁵³ ^{, 54} ^{, 55} ^{, 56} ^{, 57} ^{, 58} ^{, 59} ^{, 60} In a preliminary study, supplementing with 600 mg of alpha lipoic acid per day for 18 months slowed the progression of kidney damage in patients with type 2 diabetes.⁶¹ What Else Is This Supplement Used For?

Supplement	Amount	Why
Brewer’s Yeast	9 grams per day	Chromium-rich brewer’s yeast has been shown to be useful in treating type 2 diabetes in several ways, including by improving glucose tolerance.
Brewer’s Yeast 9 grams per day Medical reports dating back to 1853, as well as modern research, indicate that chromium-rich brewer’s yeast (9 grams per day) can be useful in treating type 2 diabetes.⁶² ^{, 63} In recent years, chromium has been shown to improve glucose levels and related variables in people with glucose intolerance and type 2, gestational, and steroid-induced diabetes.⁶⁴ ^{, 65} Improved glucose tolerance with lower or similar levels of insulin have been reported in more than ten trials of chromium supplementation in people with varying degrees of glucose intolerance.⁶⁶ Chromium supplements improve glucose tolerance in people with type 2 diabetes,⁶⁷ apparently by increasing sensitivity to insulin.⁶⁸ Chromium improves the processing of glucose in people with prediabetic glucose intolerance and in women with diabetes associated with pregnancy.⁶⁹ ^{, 70} Chromium even helps healthy people,⁷¹ although one such report found chromium useful only when accompanied by 100 mg of niacin per day.⁷² Chromium may also lower levels of total cholesterol, LDL cholesterol, and triglycerides (risk factors in heart disease).⁷³ ^{, 74} A few trials have reported no beneficial effects from chromium supplementation.⁷⁵ ^{, 76} ^{, 77} All of these trials used 200 mcg or less of supplemental chromium, which is often not adequate for people with diabetes, especially if it is in a form that is poorly absorbed. The typical amount of chromium used in research trials is 200 mcg per day, although as much as 1,000 mcg per day has been used.⁷⁸ Many doctors recommend up to 1,000 mcg per day for people with diabetes.⁷⁹ Supplementation with chromium or brewer’s yeast could potentially enhance the effects of drugs used for diabetes (e.g., insulin or other blood sugar-lowering agents) and possibly lead to hypoglycemia. Therefore, people with diabetes taking these medications should supplement with chromium or brewer’s yeast only under the supervision of a doctor. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Cayenne Topical (Diabetic Neuropathy)	Apply an ointment containing 0.025 to 0.075% capsaicin four times a day to areas of nerve pain	Topically applied capsaicin (from cayenne) may help relieve nerve pain.
Cayenne Topical Apply an ointment containing 0.025 to 0.075% capsaicin four times a day to areas of nerve pain Double-blind trials have shown that topical application of creams containing 0.025 to 0.075% capsaicin (from cayenne [Capsicum frutescens]) can relieve symptoms of diabetic neuropathy (numbness and tingling in the extremities caused by diabetes).⁸⁰ ^{, 81} Four or more applications per day may be required to relieve severe pain. This should be done only under a doctor’s supervision. What Else Is This Supplement Used For?

Supplement	Amount	Why
Chromium	200 to 1,000 mcg daily	Chromium has been shown to be useful in treating type 2 diabetes in several ways, including by improving glucose tolerance.
Chromium 200 to 1,000 mcg daily Medical reports dating back to 1853, as well as modern research, indicate that chromium-rich brewer’s yeast (9 grams per day) can be useful in treating type 2 diabetes.⁸² ^{, 83} In recent years, chromium has been shown to improve glucose levels and related variables in people with glucose intolerance and type 2, gestational, and steroid-induced diabetes.⁸⁴ ^{, 85} Improved glucose tolerance with lower or similar levels of insulin have been reported in more than ten trials of chromium supplementation in people with varying degrees of glucose intolerance.⁸⁶ Chromium supplements improve glucose tolerance in people with type 2 diabetes,⁸⁷ apparently by increasing sensitivity to insulin.⁸⁸ Chromium improves the processing of glucose in people with prediabetic glucose intolerance and in women with diabetes associated with pregnancy.⁸⁹ ^{, 90} Chromium even helps healthy people,⁹¹ although one such report found chromium useful only when accompanied by 100 mg of niacin per day.⁹² Chromium may also lower levels of total cholesterol, LDL cholesterol, and triglycerides (risk factors in heart disease).⁹³ ^{, 94} A few trials have reported no beneficial effects from chromium supplementation.⁹⁵ ^{, 96} ^{, 97} All of these trials used 200 mcg or less of supplemental chromium, which is often not adequate for people with diabetes, especially if it is in a form that is poorly absorbed. The typical amount of chromium used in research trials is 200 mcg per day, although as much as 1,000 mcg per day has been used.⁹⁸ Many doctors recommend up to 1,000 mcg per day for people with diabetes.⁹⁹ Supplementation with chromium or brewer’s yeast could potentially enhance the effects of drugs used for diabetes (e.g., insulin or other blood sugar-lowering agents) and possibly lead to hypoglycemia. Therefore, people with diabetes taking these medications should supplement with chromium or brewer’s yeast only under the supervision of a doctor. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Evening Primrose Oil	4 grams daily	Supplementing with evening primrose oil has been found to improve nerve function and to relieve pain symptoms of diabetic neuropathy.
Evening Primrose Oil 4 grams daily Supplementing with 4 grams of evening primrose oil per day for six months has been found in double-blind research to improve nerve function and to relieve pain symptoms of diabetic neuropathy.¹⁰⁰ What Else Is This Supplement Used For?

Supplement	Amount	Why
Fenugreek	2.5 to 15 grams daily	Fenugreek seeds are high in soluble fiber, which helps lower blood sugar by slowing down carbohydrate digestion and absorption.
Fenugreek 2.5 to 15 grams daily Fenugreek seeds are high in soluble fiber, which helps lower blood sugar by slowing down carbohydrate digestion and absorption. Animal research suggests that fenugreek may also contain a substance that stimulates insulin production and improves blood sugar control. In a controlled trial, incorporating 15 grams of powdered fenugreek seed into a meal eaten by people with type 2 diabetes reduced the rise in blood glucose following the meal. Another controlled trial found that taking 2.5 grams of fenugreek twice a day for three months reduced blood sugar levels in people with mild, but not those with severe, type 2 diabetes. In a double-blind study, 1 gram per day of an extract of fenugreek seeds for two months improved some measures of blood sugar control and insulin function in people with type 2 diabetes. What Else Is This Supplement Used For?

Supplement	Amount	Why
Fiber (All Forms)	Talk to your doctor	Taking fiber supplements may help to stabilize your blood sugar.
Fiber (All Forms) Talk to your doctor High-fiber supplements, such as psyllium,¹⁰¹ guar gum (found in cluster beans),¹⁰² pectin (from fruit),¹⁰³ oat bran,¹⁰⁴ and glucomannan,¹⁰⁵ ^{, 106} have improved glucose tolerance in some studies. Positive results have also been reported with the consumption of 1 to 3 ounces of powdered fenugreek seeds per day.¹⁰⁷ ^{, 108} A review of the research revealed that the extent to which moderate amounts of fiber help people with diabetes in the long term is still unknown, and the lack of many long-term studies has led some researchers to question the importance of fiber in improving diabetes.¹⁰⁹ Nonetheless, most doctors advise people with diabetes to eat a diet high in fiber. Focus should be placed on fruits, vegetables, seeds, oats, and whole-grain products. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Glucomannan	500 to 700 mg per 100 calories in the diet	Glucomannan delays stomach emptying, leading to more gradual sugar absorption and lower blood sugar levels after meals.
Glucomannan 500 to 700 mg per 100 calories in the diet Glucomannan is a water-soluble dietary fiber derived from konjac root (Amorphophallus konjac)that delays stomach emptying, leading to a more gradual absorption of dietary sugar. This effect can reduce the elevation of blood sugar levels that is typical after a meal. ¹¹⁰ After-meal blood sugar levels are lower in people with diabetes given glucomannan in their food, ¹¹¹ and overall diabetic control is improved with glucomannan-enriched diets, according to preliminary and controlled clinical trials. ¹¹² ^{, 113} ^{, 114} One preliminary report suggested that glucomannan may also be helpful in pregnancy-related diabetes. ¹¹⁵ For controlling blood sugar, 500 to 700 mg of glucomannan per 100 calories in the diet has been used successfully in controlled research. What Else Is This Supplement Used For?

Supplement	Amount	Why
Magnesium	200 to 600 mg daily	People with type 2 diabetes tend to have low magnesium levels, supplementing with the mineral may restore levels and improve insulin production.
Magnesium 200 to 600 mg daily People with type 2 diabetes tend to have low magnesium levels.¹¹⁶ Double-blind research indicates that supplementing with magnesium overcomes this problem.¹¹⁷ Magnesium supplementation has improved insulin production in elderly people with type 2 diabetes.¹¹⁸ However, one double-blind trial found no effect from 500 mg magnesium per day in people with type 2 diabetes, although twice that amount led to some improvement.¹¹⁹ Elders without diabetes can also produce more insulin as a result of magnesium supplements, according to some,¹²⁰ but not all, trials.¹²¹ However, in people with type 2 diabetes who nonetheless require insulin, Dutch researchers have reported no improvement in blood sugar levels from magnesium supplementation.¹²² The American Diabetes Association acknowledges strong associations between magnesium deficiency and insulin resistance but has not said magnesium deficiency is a risk factor¹²³ Many doctors, however, recommend that people with diabetes and normal kidney function supplement with 200 to 600 mg of magnesium per day. Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes.¹²⁴ In magnesium-deficient pregnant women with type 1 diabetes, the lack of magnesium may even account for the high rate of spontaneous abortion and birth defects associated with type 1 diabetes.¹²⁵ The American Diabetes Association admits “strong associations...between magnesium deficiency and insulin resistance” but will not say magnesium deficiency is a risk factor.¹²⁶ Many doctors, however, recommend that people with diabetes and normal kidney function supplement with 200–600 mg of magnesium per day. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Psyllium	5.1 grams daily with meals	Supplementing with psyllium has been shown to be a safe and well-tolerated way to improve control of blood glucose and cholesterol.
Psyllium 5.1 grams daily with meals Supplementing with psyllium has been shown to be a safe and well-tolerated way to improve control of blood glucose and cholesterol. In a double-blind trial, men with type 2 diabetes who took 5.1 grams of psyllium per day for eight weeks lowered their blood glucose levels by 11 to 19.2%, their total cholesterol by 8.9%, and their LDL (bad) cholesterol by 13%, compared with a placebo.¹²⁷ What Else Is This Supplement Used For?

Supplement	Amount	Why
Acetyl-L-Carnitine (Diabetic Neuropathy)	500 to 1,000 mg three times daily	Taking acetyl-L-carnitine may improve symptoms of diabetic neuropathy.
Acetyl-L-Carnitine 500 to 1,000 mg three times daily In a double-blind study of people with diabetic neuropathy, supplementing with acetyl-L-carnitine was significantly more effective than a placebo in improving subjective symptoms of neuropathy and objective measures of nerve function.¹²⁸ People who received 1,000 mg of acetyl-L-carnitine three times per day tended to fare better than those who received 500 mg three times per day. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Aloe	1 Tbsp (15 ml) of gel daily	Aloe, either alone or in combination with the oral hypoglycemic drug glibenclamide, has been shown to effectively lower blood sugar in people with type 2 diabetes.
Aloe 1 Tbsp (15 ml) of gel daily Animal research and preliminary controlled human trials have found that Aloe vera, either alone or in combination with the oral hypoglycemic drug glibenclamide, effectively lowers blood sugar in people with type 2 diabetes.¹²⁹ ^{, 130} ^{, 131} ^{, 132} The typical amount used in this research was 1 tablespoon (15 ml) of aloe gel per day. What Else Is This Supplement Used For?

Supplement	Amount	Why
American Ginseng	3 grams with or following meals	Supplementing with American ginseng may help improve blood sugar control.
American Ginseng 3 grams with or following meals In a small preliminary trial, 3 grams of American ginseng was found to lower the rise in blood sugar following the consumption of a high-glucose drink by people with type 2 diabetes.¹³³ The study found no difference in blood sugar–lowering effect if the herb was taken either 40 minutes before the drink or at the same time. A follow-up to this study found that increasing the amount of American ginseng to either 6 or 9 grams did not increase the effect on blood sugar following the high-glucose drink in people with type 2 diabetes.¹³⁴ This study also found that American ginseng was equally effective in controlling the rise in blood sugar whether it was given together with the drink or up to two hours before. What Else Is This Supplement Used For?

Supplement	Amount	Why
Asian Ginseng	200 mg of herbal extract containing approximately 5 to 7% ginsenosides daily	Asian ginseng is commonly used in traditional Chinese medicine to treat diabetes.
Asian Ginseng 200 mg of herbal extract containing approximately 5 to 7% ginsenosides daily Asian ginseng is commonly used in Traditional Chinese Medicine to treat diabetes. It has been shown in test tube and animal studies to enhance the release of insulin from the pancreas and to increase the number of insulin receptors.¹³⁵ ^{, 136} Animal research has also revealed a direct blood sugar–lowering effect of ginseng.¹³⁷ A double-blind trial found that 200 mg of ginseng extract per day improved blood sugar control, as well as energy levels in people with type 2 diabetes.¹³⁸ What Else Is This Supplement Used For?

Supplement	Amount	Why
Bilberry	160 mg twice per day of an herbal extract containing 25% anthocyanosides	Bilberry may lower the risk of some diabetic complications, such as diabetic cataracts and retinopathy.
Bilberry 160 mg twice per day of an herbal extract containing 25% anthocyanosides Bilberry may lower the risk of some diabetic complications, such as diabetic cataracts and retinopathy. One preliminary trial found that supplementation with a standardized extract of bilberry improved signs of retinal damage in some people with diabetic retinopathy.¹³⁹ What Else Is This Supplement Used For?

Supplement	Amount	Why
Biotin	9 to 16 mg daily	Biotin may improve glucose levels and reduce pain from diabetic nerve damage.
Biotin 9 to 16 mg daily Biotin is a B vitamin needed to process glucose. When people with type 2 diabetes were given 9 mg of biotin per day for two months, their fasting glucose levels dropped dramatically.¹⁴⁰ Biotin may also reduce pain from diabetic nerve damage.¹⁴¹ Some doctors try 9 to 16 mg of biotin per day for a few weeks to see if blood sugar levels will fall. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Bitter Melon	50 to 100 ml of juice daily or 5 grams three times daily of powdered fruit	Whole, fried slices, water extracts, and juice of bitter melon may improve blood-sugar control in people with type 2 diabetes.
Bitter Melon 50 to 100 ml of juice daily or 5 grams three times daily of powdered fruit Whole, fried slices,¹⁴² water extracts,¹⁴³ and juice of bitter melon may improve blood-sugar control in people with type 2 diabetes,¹⁴⁴ according to preliminary trials. However, double-blind trials are needed to confirm this potential benefit. What Else Is This Supplement Used For?

Supplement	Amount	Why
Cinnamon	1 to 6 grams daily	Cinnamon may improve glucose utilization in people with type 2 diabetes.
Cinnamon 1 to 6 grams daily Test tube studies have suggested that cinnamon may improve glucose utilization. In a study of people with type 2 diabetes, supplementing with cinnamon in the amount of 1, 3, or 6 grams per day for 40 days was significantly more effective than a placebo at reducing blood glucose levels.¹⁴⁵ The reduction averaged 18 to 29% in the three treatments groups, and 1 gram per day was as effective as 3 and 6 grams per day. The benefits of cinnamon for lowering blood sugar levels was confirmed in a double-blind study.¹⁴⁶ However, in two other double-blind studies, cinnamon was not more effective than a placebo.¹⁴⁷ ^{, 148} The different results in these studies may have been due in part to differences in body weight, initial blood sugar levels, and medication use among the different populations studied. What Else Is This Supplement Used For?

Supplement	Amount	Why
Coenzyme Q10	120 mg daily of a standardized herbal extract	Supplementing with CoQ10 may improve blood sugar metabolism.
Coenzyme Q10 120 mg daily of a standardized herbal extract Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes have been reported to be CoQ10 deficient. People with type 2 diabetes have been found to have significantly lower blood levels of CoQ10 compared with healthy people.¹⁴⁹ In one trial, blood sugar levels fell substantially in 31% of people with diabetes after they supplemented with 120 mg per day of CoQ7, a substance similar to CoQ10.¹⁵⁰ The importance of CoQ10 supplementation for people with diabetes remains an unresolved issue, though some doctors recommend approximately 50 mg per day as a way to protect against possible effects associated with diabetes-induced depletion. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Crepe Myrtle	32 or 48 mg of an herbal extract standardized to contain 1% corosolic acid	Crepe myrtle has been used in folk medicine to treat diabetes. It appears to work by lowering blood glucose levels.
Crepe Myrtle 32 or 48 mg of an herbal extract standardized to contain 1% corosolic acid Lagerstroemia speciosa, commonly known as crepe myrtle, grows in various tropical countries and Australia. In folk medicine it has been used to treat diabetes. In a preliminary study of people with type 2 diabetes, supplementing with an extract from the leaves of Lagerstroemia speciosa for two weeks resulted in a fall in blood-glucose levels averaging 20 to 30%.¹⁵¹ The amount used was 32 or 48 mg of a product standardized to contain 1% corosolic acid (a putative active ingredient). The larger amount was somewhat more effect than the smaller amount. Although these results are promising, additional studies are needed to demonstrate the long-term safety and efficacy of this herbal preparation.

Supplement	Amount	Why
Gymnema	800 mg daily of an herbal extract standardized for 25% gymnemic acids	Gymnema may stimulate the pancreas to produce insulin and may help normalize blood sugar control in people with diabetes.
Gymnema 800 mg daily of an herbal extract standardized for 25% gymnemic acids Gymnema may stimulate the pancreas to produce insulin in people with type 2 diabetes. Gymnema also improves the ability of insulin to lower blood sugar in people with both type 1 and type 2 diabetes. So far, no double-blind trials have confirmed the efficacy of gymnema for people with any type of diabetes. However, a preliminary study of type 2 diabetics reported that 400 mg per day of gymnema extract taken for periods of 18 months or longer resulted in improvement, according to diabetes blood tests, and allowed reduction of diabetic medications.¹⁵² Improvements in blood glucose levels were also seen in patients with type 2 diabetes who received 1 g per day of a specific gymnema extract (Om Santal Adivasi) for two months.¹⁵³ In a controlled trial with type 1 (insulin-dependent) diabetics, a similar amount of gymnema extract reduced requirements for insulin.¹⁵⁴ Whether the extract used in these studies was standardized for active constituents is unclear. Recently, a preliminary trial found improved blood sugar levels after three months in a group of type 1 and type 2 diabetics who took 800 mg per day of an extract standardized for 25% gymnemic acids.¹⁵⁵ Gymnema is not a substitute for insulin, but insulin amounts may need to be lowered while taking gymnema to avoid hypoglycemia. What Else Is This Supplement Used For?

Supplement	Amount	Why
Hairy Basil	10 grams three times per day with meals	Taking hairy basil may help people with type 2 diabetes control their blood sugar levels.
Hairy Basil 10 grams three times per day with meals Preliminary trials of leaves and hairy basil seeds have shown that these herbs may help people with type 2 diabetes control their blood sugar levels. An uncontrolled study reported that 1,000 mg per day of holy basil lowered blood sugar, LDL (“bad”) cholesterol, and triglycerides, while a controlled trial tested 2,500 mg per day and found similar changes in blood sugar, but only minor effects on total blood cholesterol. The mechanism of action of holy basil leaf is not understood and it is unknown whether common culinary sweet basil would have similar effects.

Supplement	Amount	Why
Holy Basil	1,000 to 2,500 mg daily	Taking holy basil may help people with type 2 diabetes control their blood sugar levels.
Holy Basil 1,000 to 2,500 mg daily Preliminary trials of holy basil (Ocimim sanctum) leaves and hairy basil (Ocimum canum) seeds have shown that these herbs may help people with type 2 diabetes control their blood sugar levels.¹⁵⁶ ^{, 157} ^{, 158} An uncontrolled study reported that 1,000 mg per day of holy basil lowered blood sugar, LDL (“bad”) cholesterol, and triglycerides,¹⁵⁹ while a controlled trial tested 2,500 mg per day and found similar changes in blood sugar, but only minor effects on total blood cholesterol.¹⁶⁰ The mechanism of action of holy basil leaf is not understood and it is unknown whether common culinary sweet basil (Ocimum basilicum) would have similar effects. What Else Is This Supplement Used For?

Supplement	Amount	Why
L-Carnitine	0.25 mg per 2.2 lbs (1 kg) of body weight	Supplementing with L-carnitine may reduce cholesterol and triglyceride levels in people with diabetes.
L-Carnitine 0.25 mg per 2.2 lbs (1 kg) of body weight L-carnitine is an amino acid needed to properly utilize fat for energy. When people with diabetes were given DL-carnitine (0.5 mg per 2.2 pounds of body weight), high blood levels of fats—both cholesterol and triglycerides—dropped 25 to 39% in just ten days in one trial.¹⁶¹ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Milk Thistle	200 mg per day of silymarin	Supplementing with silymarin (a component of milk thistle) may help lower blood sugar levels.
Milk Thistle 200 mg per day of silymarin In a double-blind trial, supplementation with 200 mg per day of silymarin (a component of milk thistle) three times per day for four months significantly lowered blood sugar levels compared with a placebo in patients who were taking a blood sugar–lowering drug (glibenclamide).¹⁶² What Else Is This Supplement Used For?

Supplement	Amount	Why
Multivitamin (Infection)	Follow label instructions	Supplementing with a multivitamin–mineral may give your body the nutrients it needs to help prevent common infections.
Multivitamin Follow label instructions In a double-blind study, supplementation of middle-aged and elderly diabetics with a multiple vitamin and mineral preparation for one year reduced the risk of infection by more than 80%, compared with a placebo.¹⁶³

Supplement	Amount	Why
Onion	20 grams fresh onion three times per day	Large amounts of onion have been shown to lower blood sugar levels in people with diabetes, possibly by blocking the breakdown of insulin in the liver.
Onion 20 grams fresh onion three times per day Preliminary trials and at least one double-blind trial have shown that large amounts of onion can lower blood sugar levels in people with diabetes.¹⁶⁴ ^{, 165} ^{, 166} The mechanism of onion’s blood sugar-lowering action is not precisely known, though there is evidence that constituents in onions block the breakdown of insulin in the liver. This would lead to higher levels of insulin in the body.¹⁶⁷ What Else Is This Supplement Used For?

Supplement	Amount	Why
Pycnogenol	100 to 150 mg per day	Preliminary research has suggested that Pycnogenol might help lower blood sugar in people with type 2 diabetes and slow progression of complications such as retinopathy.
Pycnogenol 100 to 150 mg per day Preliminary research has suggested that Pycnogenol might help lower blood sugar in people with type 2 diabetes.¹⁶⁸ Double-blind trials have shown that 100 to 125 mg per day of Pycnogenol lowers blood sugar in people with type 2 diabetes, but improvement in measures of long-term blood sugar control has not been consistent.¹⁶⁹ ^{, 170} Preliminary and double-blind studies have also shown Pycnogenol (typically 120 to 150 mg per day) slows the progression of diabetic retinopathy and improves vision.¹⁷¹ ^{, 172} ^{, 173} ^{, 174} In a controlled trial of diabetic patients with symptoms of damage to the small blood vessels of the lower legs and feet, 150 mg per day of Pycnogenol improved measures of skin health and blood flow to the feet.¹⁷⁵ In another controlled study, diabetic skin ulcers were treated with standard medications plus either 150 mg per day of Pycnogenol orally, 100 mg pycnogenol topically applied to the ulcers, or a combination of oral and topical Pycnogenol treatment.¹⁷⁶ All treatments produced complete healing in more subjects after six weeks compared with a control group receiving no Pycnogenol treatment, but the group receiving oral and topical Pycnogenol had the greatest reductions in ulcer size and in pain and other associated symptoms. What Else Is This Supplement Used For?

Supplement	Amount	Why
Vitamin B1 and Vitamin B12 (Diabetic Neuropathy)	Refer to label instructions	Taking vitamin B1 combined with vitamin B12 may improve symptoms of diabetic neuropathy.
Vitamin B1 and Vitamin B12 A controlled trial in Africa found that supplementing with both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic neuropathy after four weeks.¹⁷⁷ However, since this was a trial conducted among people in a vitamin B1–deficient developing country, these improvements might not occur in other people with diabetes. Another trial found that combining vitamin B1 (in a special fat-soluble form) and vitamin B6 plus vitamin B12 in high but variable amounts led to improvement in some aspects of diabetic neuropathy in 12 weeks.¹⁷⁸ As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.

Supplement	Amount	Why
Vitamin B1 and Vitamin B6 (Diabetic Neuropathy)	25 mg daily, with 50 mg of vitamin B6 daily	Taking vitamin B1 combined with vitamin B6 may improve symptoms of diabetic neuropathy.
Vitamin B1 and Vitamin B6 25 mg daily, with 50 mg of vitamin B6 daily A controlled trial in Africa found that supplementing with both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic neuropathy after four weeks.¹⁷⁹ However, since this was a trial conducted among people in a vitamin B1–deficient developing country, these improvements might not occur in other people with diabetes. Another trial found that combining vitamin B1 (in a special fat-soluble form) and vitamin B6 plus vitamin B12 in high but variable amounts led to improvement in some aspects of diabetic neuropathy in 12 weeks.¹⁸⁰ As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.

Supplement	Amount	Why
Vitamin B12 (Diabetic Neuropathy)	Consult a qualified healthcare practitioner	Vitamin B12 is needed for normal nerve cell function, and supplementing with it may improve symptoms of diabetic neuropathy.
Vitamin B12 Consult a qualified healthcare practitioner Vitamin B12 is needed for normal functioning of nerve cells. Vitamin B12 taken orally has reduced symptoms of nerve damage caused by diabetes in 39% of people studied; when given both intravenously and orally, two-thirds of people improved.¹⁸¹ In a preliminary trial, people with nerve damage due to kidney disease or to diabetes plus kidney disease received intravenous injections of 500 mcg of methylcobalamin (the main form of vitamin B12 found in the blood) three times a day for six months in addition to kidney dialysis. Nerve pain was significantly reduced and nerve function significantly improved in those who received the injections.¹⁸² Oral vitamin B12 up to 500 mcg three times per day is recommended by some practitioners. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin B6	1,800 mg pyridoxine alpha-ketoglutarate daily or 50 mg daily pyridoxine daily	People with diabetes often have low vitamin B6 levels. Supplementing with the vitamin may restore levels and improve glucose tolerance.
Vitamin B6 1,800 mg pyridoxine alpha-ketoglutarate daily or 50 mg daily pyridoxine daily Many people with diabetes have low blood levels of vitamin B6.¹⁸³ ^{, 184} Levels are even lower in people with diabetes who also have nerve damage (neuropathy).¹⁸⁵ Vitamin B6 supplementation has improved glucose tolerance in women with diabetes caused by pregnancy.¹⁸⁶ ^{, 187} Vitamin B6 supplementation is also effective for glucose intolerance induced by birth control pills.¹⁸⁸ In a trial that included people with type 2 diabetes, 1,800 mg per day of a special form of vitamin B6—pyridoxine alpha-ketoglutarate—improved glucose tolerance dramatically.¹⁸⁹ Standard vitamin B6 has helped in some,¹⁹⁰ but not all, trials.¹⁹¹ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin C	500 mg twice per day	Supplementing with vitamin C may benefit people with type 2 diabetes in several ways, including by reducing sorbitol levels, urinary protein loss, and glycosylation.
Vitamin C 500 mg twice per day As with vitamin E, vitamin C may reduce glycosylation.¹⁹² Vitamin C also lowers sorbitol levels in people with diabetes.¹⁹³ Sorbitol is a sugar that can accumulate inside the cells and damage the eyes, nerves, and kidneys of people with diabetes. Vitamin C may improve glucose tolerance in type 2 diabetes,¹⁹⁴ ^{, 195} although not every study confirms this benefit.¹⁹⁶ Vitamin C supplementation (500 mg twice a day for one year) has significantly reduced urinary protein loss in people with diabetes. Urinary protein loss (also called proteinuria) is associated with poor prognosis in diabetes.¹⁹⁷ Many doctors suggest that people with diabetes supplement with 1 to 3 grams per day of vitamin C. Higher amounts could be problematic, however. In one person, 4.5 grams per day was reported to increase blood sugar levels.¹⁹⁸ One study examined antioxidant supplement intake, including both vitamins E and C, and the incidence of diabetic retinopathy (damage to the eyes caused by diabetes).¹⁹⁹ Surprisingly, people with extensive retinopathy had a greater likelihood of having taken vitamin C and vitamin E supplements. The outcome of this trial, however, does not fit with most other published data and might simply reflect the fact that sicker people are more likely to take supplements in hopes of getting better. For the present, most doctors remain relatively unconcerned about the outcome of this isolated report. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin D	1,332 IU daily	Vitamin D is needed to maintain adequate insulin levels, and supplementing with it may improve blood sugar control in people with type 2 diabetes.
Vitamin D 1,332 IU daily Vitamin D is needed to maintain adequate blood levels of insulin.²⁰⁰ Vitamin D receptors have been found in the pancreas where insulin is made, and preliminary evidence suggests that supplementation can improve some measures of blood sugar control in people with type 2 diabetes.²⁰¹ ^{, 202} In addition, in a preliminary trial supplementation with about 2,000 IU of vitamin D per day for three months significantly improved pain by almost 50% in patients with diabetic neuropathy.²⁰³ Not enough is known about optimal amounts of vitamin D for people with diabetes, and high amounts of vitamin D can be toxic; therefore, people with diabetes considering vitamin D supplementation should talk with a doctor and have their vitamin D status assessed. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin E (Diabetic Retinopathy)	1800 IU daily	Vitamin E supplementation may protect against diabetic retinopathy.
Vitamin E 1800 IU daily People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes.²⁰⁵ ^{, 206} Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most,²⁰⁷ ^{, 208} ^{, 209} but not all,²¹⁰ double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes.²¹¹ ^{, 212} Three months or more of at least 900 IU of vitamin E per day may be required for benefits to become apparent. In one of the few trials to find vitamin E supplementation ineffective for glucose intolerance in people with type 2 diabetes, damage to nerves caused by the diabetes was nonetheless partially reversed by supplementing with vitamin E for six months.²¹³ Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic retinopathy and nephropathy,²¹⁴ ^{, 215} serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence. Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in many,²¹⁶ ^{, 217} ^{, 218} ^{, 219} ^{, 220} although not all,²²¹ ^{, 222} ^{, 223} studies. In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes.²²⁴ The reason for the discrepancy between reports is not known. Vitamin E appears to lower the risk of cerebral infarction, a type of stroke, in people with diabetes who smoke. A review of a large Finnish study of smokers concluded that smokers with diabetes (or hypertension) can benefit from small amounts of vitamin E (50 IU per day).²²⁵ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin E (Diabetic Neuropathy)	900 IU daily	Vitamin E supplementation may protect against neuropathy.
Vitamin E 900 IU daily People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes.²²⁶ ^{, 227} Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most,²²⁸ ^{, 229} ^{, 230} but not all,²³¹ double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes.²³² ^{, 233} Three months or more of at least 900 IU of vitamin E per day may be required for benefits to become apparent. In one of the few trials to find vitamin E supplementation ineffective for glucose intolerance in people with type 2 diabetes, damage to nerves caused by the diabetes was nonetheless partially reversed by supplementing with vitamin E for six months.²³⁴ Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic retinopathy and nephropathy,²³⁵ ^{, 236} serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence. Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in many,²³⁷ ^{, 238} ^{, 239} ^{, 240} ^{, 241} although not all,²⁴² ^{, 243} ^{, 244} studies. In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes.²⁴⁵ The reason for the discrepancy between reports is not known. Vitamin E appears to lower the risk of cerebral infarction, a type of stroke, in people with diabetes who smoke. A review of a large Finnish study of smokers concluded that smokers with diabetes (or hypertension) can benefit from small amounts of vitamin E (50 IU per day).²⁴⁶ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Zinc (Zinc Deficiency)	15 to 25 mg per day	People with type 2 diabetes tend to be zinc deficient, supplementing with zinc may help restore levels.
Zinc 15 to 25 mg per day People with type 2 diabetes tend to be zinc deficient,²⁴⁷ but some evidence indicates that zinc supplementation does not improve their ability to process sugar.²⁴⁸ Nonetheless, many doctors recommend that people with type 2 diabetes supplement with moderate amounts of zinc (15 to 25 mg per day) as a way to correct the deficit. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Açaí	Refer to label instructions	Açaí is reported to be a traditional remedy for diabetes.
Açaí Açaí is reported to be a traditional remedy for diabetes. Although oxidative stress may contribute to diabetes²⁴⁹ and anthocyanins may improve insulin secretion,²⁵⁰ there is no published evidence that açaí has any effect on diabetes. What Else Is This Supplement Used For?

Supplement	Amount	Why
Amylase Inhibitors	Refer to label instructions	Amylase inhibitors, when given with a starchy meal, can reduce the usual rise in blood sugar levels of people with diabetes.
Amylase Inhibitors Starch blockers are substances that inhibit amylase, the digestive enzyme required to break down dietary starches for normal absorption. Controlled research has demonstrated that concentrated starch blocker extracts, when given with a starchy meal, can reduce the usual rise in blood sugar levels of both healthy people and diabetics.²⁵¹ ^{, 252} ^{, 253} ^{, 254} ^{, 255} While this effect could be helpful in controlling diabetes, no research has investigated the long-term effects of taking starch blockers for this condition. What Else Is This Supplement Used For?

Supplement	Amount	Why
Fish Oil	Refer to label instructions	Supplementing with fish oil may improve glucose tolerance and symptoms of diabetic neuropathy and nephropathy
Fish Oil Glucose tolerance improves in healthy people taking omega-3 fatty acid supplements,²⁵⁶ and some studies have found that fish oil supplementation also improves glucose tolerance,²⁵⁷ high triglycerides,²⁵⁸ and cholesterol levels in people with type 2 diabetes.²⁵⁹ And in one trial, people with diabetic neuropathy and diabetic nephropathy experienced significant improvement when given 600 mg three times per day of purified eicosapentaenoic acid (EPA)—one of the two major omega-3 fatty acids found in fish oil supplements—for 48 weeks.²⁶⁰ However, other studies have found that type 2 diabetes worsens with fish oil supplementation.²⁶¹ ^{, 262} ^{, 263} ^{, 264} Until this issue is resolved, people with diabetes should feel free to eat fish, but they should consult a doctor before taking fish oil supplements. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Fructo-oligosaccharides	Refer to label instructions	In one trial, supplementing with fructo-oligosaccharides significantly lowered fasting blood-sugar levels and serum total-cholesterol levels in people with type 2 diabetes.
Fructo-oligosaccharides In a preliminary trial, supplementation with fructo-oligosaccharides (FOS) (8 grams per day for two weeks) significantly lowered fasting blood-sugar levels and serum total-cholesterol levels in people with type 2 diabetes.²⁶⁵ However, in another trial, supplementing with FOS (15 grams per day) for 20 days had no effect on blood-glucose or lipid levels in people with type 2 diabetes.²⁶⁶ In addition, some double-blind trials showed that supplementing with FOS or galacto-oligosaccharides (GOS) for eight weeks had no effect on blood-sugar levels, insulin secretion, or blood lipids in healthy people.²⁶⁷ ^{, 268} Because of these conflicting results, more research is needed to determine the effect of FOS on diabetes and lipid levels. What Else Is This Supplement Used For?

Supplement	Amount	Why
Ginkgo	Refer to label instructions	Ginkgo may help prevent and treat early-stage diabetic neuropathy.
Ginkgo Ginkgo biloba extract may prove useful for prevention and treatment of early-stage diabetic neuropathy, though research is at best very preliminary in this area.²⁶⁹ What Else Is This Supplement Used For?

Supplement	Amount	Why
Goldenseal	1 gram per day of berberine for two months	Preliminary research with berberine (an active compound in goldenseal) for two months lowered blood glucose levels in people with type 2 diabetes.
Goldenseal 1 gram per day of berberine for two months In a preliminary trial, supplementation with 1 gram per day of berberine (one of the active compounds in goldenseal) for two months significantly lowered blood glucose levels in patients with type 2 diabetes.²⁷⁰ What Else Is This Supplement Used For?

Supplement	Amount	Why
Hibiscus	Refer to label instructions	Hibiscus is a traditional remedy in India for diabetes, and is supported by preliminary research.
Hibiscus Hibiscus is a traditional remedy in India for diabetes; this treatment is supported by preliminary studies from that country and by animal studies.²⁷¹ ^{, 272} Hibiscus is usually taken as tea, such as 1 to 2 teaspoons (3 to 6 grams) of dried flower infused in to 1 cup (250 ml) three times per day. What Else Is This Supplement Used For?

Supplement	Amount	Why
Inositol	Refer to label instructions	Supplementing with inositol may improve diabetic neuropathy.
Inositol Inositol is needed for normal nerve function. Diabetes can cause a type of nerve damage known as diabetic neuropathy. This condition has been reported in some, but not all, trials to improve with inositol supplementation (500 mg taken twice per day).²⁷³ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Manganese	Refer to label instructions	People with diabetes may have low manganese levels, which can contribute to glucose intolerance. Supplementing with the mineral may help.
Manganese People with diabetes may have low blood levels of manganese.²⁷⁴ Animal research suggests that manganese deficiency can contribute to glucose intolerance and may be reversed by supplementation.²⁷⁵ A young adult with insulin-dependent diabetes who received oral manganese chloride (3 to 5 mg per day as manganese chloride) reportedly experienced a significant fall in blood glucose, sometimes to dangerously low levels. In four other cases, manganese supplementation had no effect on blood glucose levels.²⁷⁶ People with diabetes wishing to supplement with manganese should do so only with a doctor’s supervision. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Medium-Chain Triglycerides	Refer to label instructions	Medium-chain triglycerides have been found to lower blood sugar levels and may be useful in treating type 3 diabetes.
Medium-Chain Triglycerides Based on the results of a short-term clinical trial that found that medium-chain triglycerides (MCT) lower blood glucose levels,²⁷⁷ a group of researchers investigated the use of MCT to treat people with type 2 diabetes mellitus. Supplementation with MCT for an average of 17.5% of their total calorie intake for 30 days failed to improve most measures of diabetic control.²⁷⁸ What Else Is This Supplement Used For?

Supplement	Amount	Why
Mistletoe	Refer to label instructions	Mistletoe extract has been shown to stimulate insulin release from pancreas cells, and it may reduce diabetes symptoms.
Mistletoe Mistletoe extract has been shown to stimulate insulin release from pancreas cells,²⁷⁹ and animal research found that it reduces symptoms of diabetes.²⁸⁰ No research in humans has yet been published; however, given mistletoe’s worldwide reputation as a traditional remedy for diabetes, clinical trials are warranted to validate these promising preliminary findings. Traditionally, mistletoe is prepared by soaking 2 to 4 teaspoons (5 to 12 grams) of chopped mistletoe in 2 cups (500 ml) of water overnight. The mixture is drunk first thing in the morning and sweetened with honey if desired. Another batch may be left to steep during the day and drunk at bedtime. What Else Is This Supplement Used For?

Supplement	Amount	Why
Olive Leaf	Refer to label instructions	Olive leaf extracts have been used experimentally to lower high blood sugar in diabetic animals.
Olive Leaf Olive leaf extracts have been used experimentally to lower elevated blood-sugar levels in diabetic animals.²⁸¹ These results have not been reproduced in human clinical trials. What Else Is This Supplement Used For?

Supplement	Amount	Why
Quercetin	Refer to label instructions	Quercetin may be helpful for its ability to reduce levels of sorbitol—a sugar that accumulates in cells and damages the nerves, kidneys, and eyes of people with diabetes.
Quercetin Doctors have suggested that quercetin might help people with diabetes because of its ability to reduce levels of sorbitol—a sugar that accumulates in nerve cells, kidney cells, and cells within the eyes of people with diabetes—and has been linked to damage to those organs.²⁸² Clinical trials have yet to explore whether quercetin actually protects people with diabetes from neuropathy, nephropathy, or retinopathy. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Reishi	Refer to label instructions	Reishi may have some beneficial action in people with diabetes.
Reishi Animal studies and some very preliminary trials in humans suggest reishi may have some beneficial action in people with diabetes.²⁸³ ^{, 284} What Else Is This Supplement Used For?

Supplement	Amount	Why
Selenium, Vitamin A, Vitamin C, and Vitamin E (Diabetic Neuropathy)	Refer to label instructions	A combination of the antioxidants selenium, vitamin A, vitamin C, and vitamin E has been shown to improve diabetic retinopathy.
Selenium, Vitamin A, Vitamin C, and Vitamin E Because oxidation damage is believed to play a role in the development of diabetic retinopathy, antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic retinopathy. During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy.²⁸⁵ People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.

Supplement	Amount	Why
Taurine	Refer to label instructions	Supplementing with taurine may affect insulin secretion and action, and may help protect the eyes and nerves from diabetic complications.
Taurine Animal studies have shown that supplementing with taurine, an amino acid found in protein-rich food, may affect insulin secretion and action, and may have potential in protecting the eyes and nerves from diabetic complications.²⁸⁶ However, a double-blind trial found no effect on insulin secretion or sensitivity when men with high risk for developing diabetes were given 1.5 grams per day of taurine for eight weeks.²⁸⁷ In another double-blind trial, taurine supplementation (2 grams per day for 12 months) failed to improve kidney complications associated with type 2 diabetes.²⁸⁸ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vanadium	Refer to label instructions	Vanadyl sulfate, a form of vanadium, may improve glucose control in people with type 2 diabetes.
Vanadium Vanadyl sulfate, a form of vanadium, may improve glucose control in people with type 2 diabetes.²⁸⁹ ^{, 290} ^{, 291} Over a six-week period, a small group of people with type 2 diabetes were given 75 to 300 mg of vanadyl sulfate per day.²⁹² Only in the groups receiving 150 mg or 300 mg was glucose metabolism improved, fasting blood sugar decreased, and another marker for chronic high blood sugar reduced. At the 300 mg level, total cholesterol decreased, although not without an accompanying reduction in the protective HDL cholesterol. None of the amounts improved insulin sensitivity. Although there was no evidence of toxicity after six weeks of vanadyl sulfate supplementation, gastrointestinal side effects were experienced by some of the participants taking 150 mg per day and by all of the participants taking 300 mg per day. The long-term safety of the large amounts of vanadium needed to help people with type 2 diabetes (typically 100 mg per day) remains unknown. Many doctors expect that amounts this high may prove to be unsafe in the long term. What Else Is This Supplement Used For?

Supplement	Amount	Why
Vitamin B3	Refer to label instructions	Small amounts of niacin (a form of vitamin B3) may help some people with type 2 diabetes.
Vitamin B3 The intake of large amounts of niacin (a form of vitamin B3), such as 2 to 3 grams per day, may impair glucose tolerance and should be used by people with diabetes only with medical supervision.²⁹³ ^{, 294} Smaller amounts (500 to 750 mg per day for one month followed by 250 mg per day) may help some people with type 2 diabetes,²⁹⁵ though this research remains preliminary. What Else Is This Supplement Used For? See Drug Interactions

References

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209. Paolisso G, D’Amore A, Galzerano D, et al. Daily vitamin E supplements improve metabolic control but not insulin secretion in elderly type II diabetic patients. Diabetes Care 1993;16:1433–7.

210. Tütüncü NB, Bayraktar M, Varli K. Reversal of defective nerve condition with vitamin E supplementation in type 2 diabetes. Diabetes Care 1998;21:1915–8.

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217. Duntas L, Kemmer TP, Vorberg B, Scherbaum W. Administration of d-alpha-tocopherol in patients with insulin-dependent diabetes mellitus. Curr Ther Res 1996;57:682–90.

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226. Knekt P, Reunanen A, Marniumi J, et al. Low vitamin E status is a potential risk factor for insulin-dependent diabetes mellitus. J Intern Med 1999;245:99–102.

227. Salonen JT, Nyssonen K, Tuomainen T-P, et al. Increased risk of non-insulin dependent diabetes mellitus at low plasma vitamin E concentrations: a four year follow up study in men. BMJ 1995;311:1124–7.

228. Bierenbaum ML, Noonan FJ, Machlin LJ, et al. The effect of supplemental vitamin E on serum parameters in diabetics, post coronary and normal subjects. Nutr Rep Int 1985;31:1171–80.

229. Paolisso G, D’Amore A, Giugliano D, et al. Pharmacologic doses of vitamin E improve insulin action in healthy subjects and non-insulin dependent diabetic patients. Am J Clin Nutr 1993;57:650–6.

230. Paolisso G, D’Amore A, Galzerano D, et al. Daily vitamin E supplements improve metabolic control but not insulin secretion in elderly type II diabetic patients. Diabetes Care 1993;16:1433–7.

231. Tütüncü NB, Bayraktar M, Varli K. Reversal of defective nerve condition with vitamin E supplementation in type 2 diabetes. Diabetes Care 1998;21:1915–8.

232. Paolisso G, Di Maro G, Galzerano D, et al. Pharmacological doses of vitamin E and insulin action in elderly subjects. Am J Clin Nutr 1994;59:1291–6.

233. Paolisso G, Gambardella A, Galzerano D, et al. Antioxidants in adipose tissue and risk of myocardial infarction. Lancet 1994;343:596 [letter].

234. Tütüncü NB, Bayraktar M, Varli K. Reversal of defective nerve condition with vitamin E supplementation in type 2 diabetes. Diabetes Care 1998;21:1915–8.

235. Ross WM, Creighton MO, Stewart-DeHaan PJ, et al. Modelling cortical cataractogenesis: 3. In vivo effects of vitamin E on cataractogenesis in diabetic rats. Can J Ophthalmol 1982;17:61.

236. Bursell SE, Schlossman DK, Clermont AC, et al. High-dose vitamin E supplementation normalizes retinal blood flow and creatinine clearance in patients with type I diabetes. Diabetes Care 1999;22:1245–51.

237. Ceriello A, Giugliano D, Quatraro A, et al. Vitamin E reduction of protein glycosylation in diabetes. Diabetes Care 1991;14:68–72.

238. Duntas L, Kemmer TP, Vorberg B, Scherbaum W. Administration of d-alpha-tocopherol in patients with insulin-dependent diabetes mellitus. Curr Ther Res 1996;57:682–90.

239. Paolisso G, D’Amore A, Galzerano D, et al. Daily vitamin E supplements improve metabolic control but not insulin secretion in elderly type II diabetic patients. Diabetes Care 1993;16:1433–7.

240. Jain SK, McVie R, Jaramillo JJ, et al. Effect of modest vitamin E supplementation on blood glycated hemoglobin and triglyceride levels and red cell indices in type I diabetic patients. J Am Coll Nutr 1996;15:458–61.

241. Jain SK, McVie R, Smith T. Vitamin E supplementation restores glutathione and malondialdehyde to normal concentrations in erythrocytes of type 1 diabetic children. Diabetes Care 2000;23:1389–94.

242. Reaven PD, Barnett J, Herold DA, Edelman S. Effect of vitamin E on susceptibility of low-density lipoprotein and low-density lipoprotein subfractions to oxidation and on protein glycation in NIDDM. Diabetes Care 1995;18:807.

243. Bursell S-E, Schlossman DK, Clermont AC, et al. High-dose vitamin E supplementation normalizes retinal blood flow and creatineine clearance in patients with type I diabetes. Diabetes Care 1999;22:1245–51.

244. Fuller CJ, Chandalia M, Garg A, et al. RRR-alpha-tocopheryl acetate supplementation at pharmacologic doses decreases low-density-lipoprotein oxidative susceptibility but not protein glycation in patients with diabetes mellitus. Am J Clin Nutr 1996;63:753–9.

245. Skrha J, Sindelka G, Kvasnicka J, Hilgertova J. Insulin action and fibrinolysis influenced by vitamin E in obese type 2 diabetes mellitus. Diabetes Res Clin Pract 1999;44:27–33.

246. Leppälä JM, Virtamo J, Fogelholm R, et al. Vitamin E and beta carotene supplementation in high risk for stroke: A subgroup analysis of the alpha-tocopherol, beta-carotene cancer prevention study. Arch Neurol 2000;57:1503–9.

247. Nakamura T, Higashi A, Nishiyama S, et al. Kinetics of zinc status in children with IDDM. Diabetes Care 1991;14:553–7.

248. Niewoehner CB, Allen JI, Boosalis M, et al. Role of zinc supplementation in type II diabetes mellitus. Am J Med 1986;81:63–8.

249. Maxwell SR, et al. Poor glycaemic control is associated with reduced serum free radical scavenging (antioxidant) activity in non-insulin-dependent diabetes mellitus. Ann Clin Biochem 1997;34( Pt 6):638–44.

250. Jayaprakasam B, Vareed SK, Olson LK, Nair MG. Insulin secretion by anthocyanins and anthocyanidins. J Agric Food Chem 2005;53:28–31.

251. Boivin M, Zinsmeister AR, Go VL, DiMagno EP. Effect of a purified amylase inhibitor on carbohydrate metabolism after a mixed meal in healthy humans. Mayo Clin Proc 1987;62:249–55.

252. Boivin M, Flourie B, Rizza RA, et al. Gastrointestinal and metabolic effects of amylase inhibition in diabetics. Gastroenterology 1988;94:387–94.

253. Lankisch M, Layer P, Rizza RA, DiMagno EP. Acute postprandial gastrointestinal and metabolic effects of wheat amylase inhibitor (WAI) in normal, obese, and diabetic humans. Pancreas 1998;17:176–81.

254. Holt PR, Thea D, Yang MY, Kotler DP. Intestinal and metabolic responses to an alpha-glucosidase inhibitor in normal volunteers. Metabolism 1988;37:1163–70.

255. Layer P, Rizza RA, Zinsmeister AR, et al. Effect of a purified amylase inhibitor on carbohydrate tolerance in normal subjects and patients with diabetes mellitus. Mayo Clin Proc 1986;61:442–7.

256. Zak A, Zeman M, Hrabak P, et al. Changes in the glucose tolerance and insulin secretion in hypertriglyceridemia: effects of dietary n-3 fatty acids. Nutr Rep Int 1989;39:235–42.

257. Popp-Snijders C, Schouten JA, Heine RJ, et al. Dietary supplementation of omega-3 polyunsaturated fatty acids improves insulin sensitivity in non-insulin-dependent diabetes. Diabetes Res 1987;4:141–7.

258. Albrink MJ, Ullrich IH, Blehschmidt NG, et al. The beneficial effect of fish oil supplements on serum lipids and clotting function of patients with type II diabetes mellitus. Diabetes 1986;35 (suppl 1):43A [abstract #172].

259. Wei I, Ulchaker M, Sheehan J. Effect of omega-3 fatty acids (FA) in non-obese non-insulin dependent diabetes (NIDDM). Am Clin Nutr 1988;47:775 [abstract #70].

260. Okuda Y, Mizutani M, Ogawa M, et al. Long-term effects of eicosapentaenoic acid on diabetic peripheral neuropathy and serum lipids in patients with type II diabetes mellitus. J Diabetes Complications 1996;10:280–7.

261. Vandongen R, Mori TA, Codde JP, et al. Hypercholesterolaemic effect of fish oil in insulin-dependent diabetic patients. Med J Aust 1988;148:141–3.

262. Schectman G, Kaul S, Kissebah AH. Effect of fish oil concentrate on lipoprotein composition in NIDDM. Diabetes 1988;37:1567–73.

263. Stackpoole PW, Alig J, Kilgore LL, et al. Lipodystrophic diabetes mellitus. Investigations of lipoprotein metabolism and the effects of omega-3 fatty acid administration in two patients. Metabolism 1988;37:944–51.

264. Glauber H, Wallace P, Griver K, Brechtel G. Adverse metabolic effect of omega-3 fatty acids in non-insulin-dependent diabetes mellitus. Ann Intern Med 1988;108:663–8.

265. Yamashita K, Kawai K, Itakura M. Effect of fructo-oligosaccharides on blood glucose and serum lipids in diabetic subjects. Nutr Res 1984;4:961–6.

266. Roberfroid M. Dietary fibre, inulin and oligofructose. A review comparing their physiological effects. Crit Rev Food Sci Nutr 1993;33:103–48 [review].

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Last Review: 08-17-2011

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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2013.

Topic Contents

Type 2 Diabetes

Need to Know

About

About This Condition

Holistic Options

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Add some olive oil

Feast on fish

Fight back with fiber

Go vegetarian or vegan

Keep an eye on the GI

Limit sugar

Supplements

What Are "Star" Ratings?

Alpha Lipoic Acid

Brewer’s Yeast

Cayenne Topical

Chromium

Evening Primrose Oil

Fenugreek

Fiber (All Forms)

Glucomannan

Magnesium

Psyllium

Acetyl-L-Carnitine

Aloe

American Ginseng

Asian Ginseng

Bilberry

Biotin

Bitter Melon

Cinnamon

Coenzyme Q10

Crepe Myrtle

Gymnema

Hairy Basil

Holy Basil

L-Carnitine

Milk Thistle

Multivitamin

Onion

Pycnogenol

Vitamin B1 and Vitamin B12

Vitamin B1 and Vitamin B6

Vitamin B12

Vitamin B6

Vitamin C

Vitamin D

Vitamin E

Vitamin E

Zinc

Açaí

Amylase Inhibitors

Fish Oil

Fructo-oligosaccharides

Ginkgo

Goldenseal

Hibiscus

Inositol

Manganese

Medium-Chain Triglycerides

Mistletoe

Olive Leaf

Quercetin

Reishi

Selenium, Vitamin A, Vitamin C, and Vitamin E

Taurine

Vanadium

Vitamin B3

References